Provider Demographics
NPI:1245595370
Name:EWA ZYSK DENTISTRY P.C.
Entity Type:Organization
Organization Name:EWA ZYSK DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYSK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-577-4016
Mailing Address - Street 1:350 BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-2302
Mailing Address - Country:US
Mailing Address - Phone:631-842-8100
Mailing Address - Fax:631-842-8101
Practice Address - Street 1:350 BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-2302
Practice Address - Country:US
Practice Address - Phone:631-842-8100
Practice Address - Fax:631-842-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0533981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty